Three cases of left ventricular stenosis due to characteristic morphology

Abstract

We report three cases of left ventricular stenosis in patients with other than hypertrophic obstructive cardiomyopathy or hypertrophic cardiomyopathy with midventricular obstruction. Case 1 was a patient diagnosed with takotsubo cardiomyopathy, and transthoracic echocardiography (TTE) revealed left ventricular outflow tract stenosis due to sigmoid septum and hypercontraction of the left ventricular base. The mitral valve anterior apex was long in morphology and the left ventricular outflow tract stenosis also appeared, indicating systolic anterior motion (SAM) and associated moderate mitral regurgitation (MR). Case 2 had breathlessness on exertion, and coronary angiography (CAG) showed no significant stenosis. TTE revealed a form of concentric remodeling and sigmoid septum, with no left ventricular outflow tract stenosis, but a long mitral apex, SAM-like, and mild MR. A master two-step test was performed until the onset of symptoms, and symptoms appeared after 5 minutes of loading. TTE at that time showed left ventricular stenosis at mid level. Case 3 was under observation for exertional angina pectoris and complained of breathlessness, although CAG showed no significant stenosis. TTE showed concentric remodeling, narrowing of the lumen, and a tendency for the lumen to disappear during systole, but no accelerated blood flow, but when Valsalva loading was performed, left ventricular stenosis was observed at mid level. Characteristic morphology led to the appearance of left ventricular accelerated blood flow, and TTE was useful in one case to detect the cause of MR due to left ventricular outflow tract stenosis, and in two cases to detect subclinical left ventricular stenosis.